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Prevalence of heart disease in older women in a nursing home
1Hebrew Hospital Home, New York, USA.
Insights
Coronary artery disease affects older men and women similarly. However, hypertension and left ventricular hypertrophy are significant risk factors for new coronary events in older women.
Area of Science:
- Cardiology
- Geriatric Medicine
- Epidemiology
Background:
- Coronary artery disease (CAD) and new coronary events affect older men and women equally.
- Older women exhibit a higher prevalence of hypertension compared to older men.
- Specific cardiac conditions like rheumatic mitral stenosis and mitral annular calcium are more common in older women.
Purpose of the Study:
- To identify independent risk factors for new coronary events in older women.
- To investigate the predictive value of left ventricular hypertrophy in older women with hypertension.
- To examine the prevalence and incidence of heart failure and atrial fibrillation in the elderly population.
Main Methods:
- Analysis of epidemiological data on cardiovascular disease prevalence and incidence in older adults.
- Identification of independent risk factors for new coronary events through statistical modeling.
- Echocardiographic assessment of left ventricular hypertrophy in hypertensive women.
Main Results:
- Age, prior CAD, smoking, hypertension, diabetes, high cholesterol/triglycerides, and low HDL cholesterol are risk factors for new coronary events in older women.
- Left ventricular hypertrophy is a strong predictor of coronary events, stroke, and heart failure in hypertensive older women.
- Prevalence of heart failure with preserved ejection fraction and chronic atrial fibrillation increases with age, being higher in older women.
Conclusions:
- Hypertension and left ventricular hypertrophy are critical concerns for cardiovascular risk in older women.
- Atrial fibrillation poses a significant risk for coronary events and stroke in older women.
- Evaluation for prolonged pauses on ambulatory ECG is crucial for older women with unexplained syncope.
Abstract:
The prevalence of coronary artery disease (CAD) and the incidence of new coronary events are similar in older men and women. Independent risk factors for new coronary events in older women include age, prior CAD, cigarette smoking, hypertension, diabetes mellitus, high serum total cholesterol and triglycerides, and low serum high-density lipoprotein cholesterol. Older women have a higher prevalence of hypertension than older men. In older women with hypertension, echocardiographic left ventricular hypertrophy is a powerful independent predictor of new coronary events, atherothrombotic brain infarction, and congestive heart failure (CHF). Older women have a higher prevalence of rheumatic mitral stenosis and of mitral annular calcium than older men. Older women and men have a similar prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy. The prevalence and incidence of CHF increase with age. The prevalence of normal left ventricular ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and is similar in older men and women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older women. Older women with unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses > 3 seconds are present, requiring permanent pacemaker implantation.